Benzodiazepine Therapy: The Good, The Bad, and The Ugly

Benzodiazepines are some of the most commonly prescribed medications worldwide. When used appropriately for the right condition, patient, dose, and duration, these drugs can provide rapid relief of the symptoms of anxiety and insomnia for some patients, but they are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients are prescribed, and take, benzodiazepines long-term without ever receiving evidence-based first-line treatments such as psychotherapy, relaxation techniques, sleep hygiene education, or serotonergic agents. This chapter discusses the risks and benefits of, and alternatives to, benzodiazepines. The evidence-based indications and contraindications are discussed, as are putative biopsychosocial bases for effectiveness, ineffectiveness, and harm. The known potential adverse effects and drug-drug interactions are summarized. Finally, alternative fast-acting/acute and chronic treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—must be assessed.